Journal of Plastic Reconstructive and Aesthetic Surgery最新文献

{"title":"Thighs lift in the post-bariatric patient – A systematic review","authors":"","doi":"10.1016/j.bjps.2024.09.011","DOIUrl":"10.1016/j.bjps.2024.09.011","url":null,"abstract":"<div><h3>Background</h3><div>Thigh lift, first described by Lewis in 1957, consists of thigh recontouring by various strategies. In post-bariatric thigh lift (PBTL), the technical details become fundamental due to both patient comorbidities and increased risk of complications. Moreover, post-bariatric weight loss affects the thighs, resulting in significant tissue redundancy, inner excess, lower thigh deformity, later excess, and buttocks ptosis. With the present paper, a systematic review of PBTL procedures is reported and a comprehensive classification system is proposed, aiming to improve their medical and surgical management.</div></div><div><h3>Methods</h3><div>A Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) systematic review was carried out by searching the PubMed (MEDLINE) database from May 2004 to May 2024 using the search string “thighplasty OR thigh lift OR post-bariatric thighplasty OR (thigh lift AND weight loss) OR (thigh lift AND liposuction)”. Original studies discussing PBTL with a minimum of three clinical cases were eligible for inclusion.</div></div><div><h3>Results</h3><div>The final synthesis included 17 articles and 496 patients. The articles were published in the last 20 years. Several papers discussed significant PBTL surgical strategies and technical measures.</div></div><div><h3>Conclusions</h3><div>PBTL is challenging because of both technical factors and complex comorbidities of post-bariatric patients. This comprehensive assessment of PBTL may help in choosing the appropriate treatment based on a patient’s individual needs. Liposuction-assisted inner thigh lift with combined horizontal-vertical scars and skin-only excision is effective and versatile for most patients. However, select cases may benefit from alternative and more invasive strategies. Artificial intelligence is a topic of growing interest, and it will probably become increasingly relevant in PBTL.</div></div>","PeriodicalId":50084,"journal":{"name":"Journal of Plastic Reconstructive and Aesthetic Surgery","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142327527","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The curious case of medical advisor: The house of cards in aesthetic medicine","authors":"","doi":"10.1016/j.bjps.2024.09.020","DOIUrl":"10.1016/j.bjps.2024.09.020","url":null,"abstract":"","PeriodicalId":50084,"journal":{"name":"Journal of Plastic Reconstructive and Aesthetic Surgery","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142238358","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Taps, wicks, bridges and LIFTs: Clarification on the origins of lymphatic flaps","authors":"","doi":"10.1016/j.bjps.2024.09.018","DOIUrl":"10.1016/j.bjps.2024.09.018","url":null,"abstract":"","PeriodicalId":50084,"journal":{"name":"Journal of Plastic Reconstructive and Aesthetic Surgery","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142238355","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term results and patient-reported outcomes after vascularized fibular graft use in the treatment of post-traumatic bone defects of femur shaft and tibia: A retrospective cohort and cross-sectional survey study","authors":"","doi":"10.1016/j.bjps.2024.08.056","DOIUrl":"10.1016/j.bjps.2024.08.056","url":null,"abstract":"<div><h3>Objectives</h3><p>Post-traumatic critical-sized bone defects pose a reconstructive challenge for reconstructive surgeons. The vascularized fibula graft is a well-described treatment for osseous defects of the femur and tibia. This study aimed to assess long-term patient-reported quality of life, the success-, and complication rates in lower extremity reconstruction with vascularized fibula grafts.</p></div><div><h3>Methods</h3><p>A retrospective cohort of 29 patients who underwent fibula graft reconstruction for critical-sized bone defects after post-traumatic tibial and femoral bone loss between 1990 and 2021 was included. To assess the health-related quality of life and return to work and satisfaction, a cross-sectional survey was performed using the short-form-36, lower extremity functional scale, and a self-made questionnaire including the DN4, satisfaction, and subjective ankle function.</p></div><div><h3>Results</h3><p>The median bone defect size was 8 cm (IQR 9–7 cm). The mental component scores were comparable to the Dutch population norm, whereas the impaired physical function scores were associated with pain (r 0.849, <em>p</em> &lt; 0.001). Neuropathic symptoms were reported in 7 out of 19 patients, and 11 out of 19 patients returned to normal daily activity. All respondents reported positive or neutral scores on overall satisfaction with the recovery. Bone healing was uneventful in 19 out of 29 patients. Union was achieved in 25 out of 29 patients. Persistent nonunion was observed in 4 patients, leading to amputation in 2 patients.</p></div><div><h3>Conclusion</h3><p>Vascularized fibula graft use led to high union rates and limb salvage in patients with post-traumatic segmental bone loss of the tibia and femur. Patient satisfaction with the overall recovery was positive; however, functional outcomes remained impaired.</p></div>","PeriodicalId":50084,"journal":{"name":"Journal of Plastic Reconstructive and Aesthetic Surgery","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1748681524005175/pdfft?md5=b49e16b5dc949e46a6990d57026f454c&pid=1-s2.0-S1748681524005175-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142163923","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comprehensive treatment approach for hemifacial microsomia: Integrating orthognathic surgery with sequential customized implantation","authors":"","doi":"10.1016/j.bjps.2024.09.015","DOIUrl":"10.1016/j.bjps.2024.09.015","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to evaluate the clinical outcomes of combining orthognathic surgery with staged patient-specific implants (PSIs) for comprehensive craniofacial asymmetry reconstruction in adult patients with hemifacial microsomia (HFM).</div></div><div><h3>Methods</h3><div>Six adults with HFM (1 Type I and 5 Type IIa) underwent orthognathic surgery to correct skeletal malocclusion and chin deviation. Sequential PSIs were implanted to address craniofacial asymmetry. Digital lateral cephalograms and cranial computed tomography scans were obtained at four time points: pre-orthognathic surgery (T0), within three months after orthognathic surgery (T1), one year after orthognathic surgery and just before personalized implantation (T2), and after personalized implantation (T3). Evaluation parameters included skeletal and dentoalveolar measures, occlusal cant, chin deviation, skeletal stability, and facial contour symmetry.</div></div><div><h3>Results</h3><div>At T1, no significant differences were observed in skeletal movements compared with planned surgical movements (<em>p</em> &gt; 0.05). Similarly, at T2, skeletal movements did not significantly differ from those observed at T1 (<em>p</em> &gt; 0.05), indicating surgical precision and stability. Analysis of skeletal and dentoalveolar parameters, occlusal cant, and chin deviation revealed significant increases in SNB, FH-NPo, and ST N vert-Pog at T1 compared to T0 (<em>p</em> &lt; 0.05), along with notable improvements in chin deviation and occlusal cant (<em>p</em> &lt; 0.05). Comparison of T2 to T1 showed no significant changes in SNB, FH-NPo, ST N vert-Pog, chin deviation, or occlusal cant (<em>p</em> &gt; 0.05), indicating substantial postoperative stability. After personalized implantation (T3), further significant improvements were observed in skeletal symmetry.</div></div><div><h3>Conclusion</h3><div>Combining orthognathic surgery with staged PSIs effectively reconstructs craniofacial asymmetry in adult patients with HFM, achieving significant improvements in skeletal alignment, occlusal cant, and chin deviation, with stable outcomes over time.</div></div>","PeriodicalId":50084,"journal":{"name":"Journal of Plastic Reconstructive and Aesthetic Surgery","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142515420","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"DaxibotulinumtoxinA for injection to treat moderate or severe glabellar lines: A randomized, multicenter, Phase III, double-blind, placebo-controlled trial in China","authors":"","doi":"10.1016/j.bjps.2024.09.012","DOIUrl":"10.1016/j.bjps.2024.09.012","url":null,"abstract":"<div><h3>Background</h3><div>DaxibotulinumtoxinA for injection (DAXI), a novel botulinum toxin type A formulation, is FDA-approved for glabellar lines treatment. Its clinical efficacy has been demonstrated in two Phase III trials (SAKURA 1 and SAKURA 2).</div></div><div><h3>Objective</h3><div>To evaluate DAXI efficacy and safety in Chinese adults with moderate/severe glabellar lines.</div></div><div><h3>Methods</h3><div>In this Phase III, randomized (2:1), double-blind trial, Chinese adults with moderate/severe glabellar lines received 40 U DAXI or placebo into the corrugator muscles bilaterally and the procerus. Glabellar line severity was evaluated by investigators (Investigator Global Assessment-Frown Wrinkle Severity [IGA-FWS] scale) and participants (Patient Frown Wrinkle Severity [PFWS] scale) for ≥24 to 36 weeks. The primary endpoint was the proportion of 2-point composite responders achieving ≥2-point reduction in IGA-FWS and PFWS scores at week 4 post-treatment.</div></div><div><h3>Results</h3><div>Overall, 307 participants received treatment (DAXI, 205; placebo, 102). A significantly greater proportion of participants in the DAXI arm vs the placebo arm achieved a 2-point composite response at week 4: 125 (61.0%) vs 1 (1.0%); difference, 60.0% [95% CI 49.40–66.46]; 2-sided p &lt; 0.0001). At week 4, 94.1% of the DAXI-treated participants achieved an IGA-FWS score 0/1 (none/mild) and 86.3% achieved PFWS 0/1; median time to loss of none/mild on IGA-FWS and PFWS was 23.9 weeks. The benefits of DAXI over placebo through week 24 occurred regardless of the baseline IGA-FWS score, prior botulinum toxin type A (BoNTA) exposure, sex or age. DAXI was well tolerated with no new safety signals.</div></div><div><h3>Conclusion</h3><div>DAXI provided durable efficacy and acceptable safety for treating moderate/severe glabellar lines in Chinese participants.</div></div>","PeriodicalId":50084,"journal":{"name":"Journal of Plastic Reconstructive and Aesthetic Surgery","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142358068","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Contralateral submental artery island flap for oral tongue reconstruction — a retrospective study in patients with oral tongue squamous cell carcinoma","authors":"","doi":"10.1016/j.bjps.2024.09.005","DOIUrl":"10.1016/j.bjps.2024.09.005","url":null,"abstract":"<div><h3>Background</h3><div>Oral squamous cell carcinoma (OSCC) is a leading cause of cancer-related deaths in developing countries. The oral tongue is the most common site involved by OSCC. About one-third of the patients have neck nodal metastasis at presentation. Oral tongue reconstruction after resection for cancer is necessary for proper rehabilitation. For patients who are medically unfit for prolonged surgery like a free tissue transfer, local flaps are employed for tongue reconstruction. The submental flap is a popular option. However, when there is an extensive floor of mouth involvement or bulky nodal disease in ipsilateral level 1, submental flap harvesting based on contralateral facial vessels is possible without compromising oncological safety. This study discusses the feasibility and outcomes of contralateral submental artery island flap (SMIF) for reconstruction after resection of oral tongue carcinoma in a retrospective series of 34 patients followed up for a median of 8.5 months.</div></div><div><h3>Results</h3><div>Of the 34 oral tongue cancer patients in the study, 16 had neoadjuvant chemotherapy before surgery. Thirty-three underwent bilateral neck dissection. Two patients had partial flap loss, which was managed conservatively. Five patients had either locoregional or distant recurrence, but none in the flap site. Three had pathological positive nodes at ipsilateral level 1b, and one had pathologically positive nodes at contralateral level 1b. Tongue motility and speech intelligibility were satisfactory on follow-up.</div></div><div><h3>Conclusion</h3><div>In the properly selected patient, contralateral SMIF offers an oncologically safe and technically simpler alternative for free flap reconstruction.</div></div>","PeriodicalId":50084,"journal":{"name":"Journal of Plastic Reconstructive and Aesthetic Surgery","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142323401","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Noninvasive visualization of the midline-crossing arterial variation in the deep inferior epigastric artery perforator flap using photoacoustic tomography for application in patients with abdominal scars","authors":"","doi":"10.1016/j.bjps.2024.09.010","DOIUrl":"10.1016/j.bjps.2024.09.010","url":null,"abstract":"<div><h3>Background</h3><div>The importance of the subcutaneous arterial network crossing the midline in transverse abdominal flaps has been reported. Photoacoustic tomography can be used to noninvasively visualize subcutaneous vascular networks. We applied this novel technology preoperatively in patients undergoing breast reconstruction to detect individual variations in the midline-crossing arteries.</div></div><div><h3>Methods</h3><div>Six patients scheduled to undergo breast reconstruction using free deep inferior epigastric artery perforator flaps were examined. Each scan of the 12 × 8-cm region took approximately 8 min. The accuracy of the tentative artery evaluation defined by photoacoustic tomography was compared with the arterial phase detected by intraoperative indocyanine green angiography. The number of perforator vessels used for the flap, surgical time for flap elevation, and perfusion area ratio were compared with those of the control group.</div></div><div><h3>Results</h3><div>The average match rate between tentative artery prediction by photoacoustic tomography and arterial-phase assessment by intraoperative angiography in five patients was 79.8%. Each midline-crossing artery showed individual variations. The photoacoustic tomography group (PAT-1 to 5) showed 1.8 perforators per flap, 163 min for flap elevation, and 93% perfusion area, with no significant differences from the control group (N = 5). A 63-year-old woman (PAT-6) with abdominal scars, including a midline abdominal incision, showed a preserved midline-crossing artery. The planned single perforator deep inferior epigastric perforator flap was successfully applied to the contralateral perfusion area.</div></div><div><h3>Conclusions</h3><div>Photoacoustic tomography noninvasively visualizes the subcutaneous midline-crossing arterial networks. Understanding individual vascular variations can support preoperative planning and surgical indication of abdominal flaps, especially in patients with postsurgical scars.</div></div>","PeriodicalId":50084,"journal":{"name":"Journal of Plastic Reconstructive and Aesthetic Surgery","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142322929","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evolving role of staging CT scans during CT-angiography for DIEP flap reconstruction planning","authors":"","doi":"10.1016/j.bjps.2024.09.009","DOIUrl":"10.1016/j.bjps.2024.09.009","url":null,"abstract":"<div><h3>Background</h3><div>Preoperative planning with CT-angiography (CTA) in deep inferior epigastric perforator (DIEP) flap reconstruction is an essential preoperative tool. The aim of this study was to describe the management of the incidental findings following the introduction and further modification of a combined CTA and CT-staging preoperative protocol which includes chest, abdomen, pelvis, and musculoskeletal system.</div></div><div><h3>Material and methods</h3><div>A retrospective case series of 292 patients (Group 1) with breast cancer who underwent DIEP flap between 2015 and 2019. This was followed by a re-assessment between 2019 and 2021 of 101 patients (Group 2) following modification of the staging-CT protocol to include only those patients who received chemotherapy. Group 1 included immediate and delayed reconstruction; whereas Group 2 included only the high-risk delayed reconstruction cases. Both groups had CT staging.</div></div><div><h3>Result</h3><div>Overall, 30% of Group 1, most likely those who had the delayed reconstruction, had findings which were recommended for further follow-up. This led to a change in staging of the high-risk patients only at the end of 2019 to those who underwent chemotherapy and had delayed reconstruction.</div><div>Briefly, 56.4% of Group 2 demonstrated incidental findings, 42.1% of them required repeat scanning, 7% were referred to other specialties, and 47.4% did not require further action. There were no cases of occult metastatic breast cancer in either series; however, 1% were diagnosed with de novo primary cancers at non breast sites only in the first series.</div></div><div><h3>Conclusion</h3><div>The screening of patients with asymptomatic breast cancer as part of CTA scanning prior to autologous reconstruction is not universally practiced and not supported by the NICE guidelines. This unit changed the practice to stop preoperative staging for low-risk patients by the end of 2019, and reserved it for the high-risk patient groups to reduce cost.</div></div>","PeriodicalId":50084,"journal":{"name":"Journal of Plastic Reconstructive and Aesthetic Surgery","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142323400","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding the role of intraoperative hypothermia in perioperative opioid requirements in immediate implant-based breast reconstruction","authors":"","doi":"10.1016/j.bjps.2024.08.074","DOIUrl":"10.1016/j.bjps.2024.08.074","url":null,"abstract":"<div><h3>Background</h3><p>The relationship between perioperative temperatures and postoperative pain is unknown. The present study investigated the relationship of intraoperative hypothermia and perioperative opioid requirements after immediate implant-based breast reconstruction.</p></div><div><h3>Methods</h3><p>A retrospective chart review was conducted on patients undergoing immediate implant-based breast reconstruction from 2019–2023. Patients were classified into the hypothermic group (majority of procedure &lt;36.0 °C) or normothermic group (majority of procedure ≥36.0 °C). Cumulative inpatient opioid requirements (morphine milli-equivalents [MMEs]) and frequency of patients requiring “high-dose opioids” (≥100 MMEs) were collected and compared between the groups.</p></div><div><h3>Results</h3><p>In total, 536 patients (835 breasts) were included, among whom 135 (25.1%) were hypothermic. The hypothermic group had lower mean intraoperative (88.4 vs. 99.1 MMEs, P = 0.007) and postoperative (45.6 vs. 56.8 MMEs, P = 0.006) than the normothermic group. Mean (B = 14.6, P = 0.004) and nadir (B = 10.4, P = 0.038) intraoperative temperatures directly predicted higher opioid requirements while higher percentages of the procedure time spent under 36 °C (B = −27.6, P = 0.004) predicted lower opioid requirements. The hypothermic group was associated with 66% decreased odds of requiring high-dose opioids after adjusting for differences in patient and operative characteristics (P = 0.007).</p></div><div><h3>Conclusion</h3><p>Hypothermia is associated with decreased perioperative opioid requirements. Future studies should further investigate ideal temperature thresholds for warming protocols to minimize postoperative pain.</p></div>","PeriodicalId":50084,"journal":{"name":"Journal of Plastic Reconstructive and Aesthetic Surgery","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142238357","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}